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General NPI Number Information
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NPI Number | 1003977992
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Entity Type | Organization
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Legal Business Name | SCR PENNSYLVANIA INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 7100 TORRESDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-1313
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Country | US
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Telephone | 215-624-0919
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 TORRESDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-1313
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Country | US
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Telephone | 215-624-0919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTONIO MARIO SELLECCHIA JR.
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Credential | RPH
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Telephone | 215-624-0919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP412161L
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License Number State | PA
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